From: Sumner,Walt 
To: Norman Kjono 
Sent: Tuesday, June 03, 2003 10:25 AM
Subject: RE: Replacing Cigarettes With Nicotine Inhalers


Norman - 

Thanks for the publicity. Maybe you'll generate some tobacco control funding for me someday!

But seriously, some comments:

Page 2, 1st column, toward the bottom, the sentence beginning "The answer to is Dr. Sumner's model assumes..." needs rewording. 

Page 2, 2nd column, bottom of column, the paragraph beginning "A differing view of Dr. Sumner's statement is..." and ensuing discussion is a provocative distortion of my argument. My father died last year at age 65 of the tobacco curse, suffering from no less than four fatal smoking-related diseases, none of them related to nicotine, all of them related to smoke, including two that happen almost exclusively in smokers. I would much rather have him addicted to nicotine than not have him at all. I have seen quite a few families who have similar feelings, often in intensive care waiting rooms. You should be careful about churning out this profit motive stuff when you rephrase clinician's arguments. Burying people you know is painful. Perhaps you remember that from your time in Vietnam. I hope you don't have to do it again anytime soon, but if you do, I hope you will take the opportunity to reconsider your stance on this article. I understand that serving patients is going to require creating a win-win-win scenario for smokers, pharma and tobacco, and governments, and that for three of those groups, all that matters is money. But the people we know are what really matters in the end. The question is, what practical approach can we take to tobacco that will actually help smokers who are getting hurt?

Page 4, 1st column, "what actually occurs is not relevant" - LOL, I can't believe you ventured that! The whole model is about understanding what might really happen. Furthermore, a large number of the 'tobacco control' suggestions are what we would call "informed consent" in medicine. This is closely related to the economic idea of having rational, informed consumers. Big tobacco has never been too excited about well informed consumers, and neither is big pharma, or any other industry, so if citizens want to make informed purchases, someone will have to convince cos. to warn of predictable harms. I would think that FORCES, if it it truly endorses the banner, "WE BELIEVE CONSUMERS HAVE THE RIGHT TO CHOOSE THEIR LIFESTYLES WITHOUT GOVERNMENT INTERFERENCE!", would be all over informed choice. Unless you think information is government interference: "WE BELIEVE CONSUMERS HAVE THE RIGHT TO CHOOSE THEIR LIFESTYLES WITHOUT INFORMATION." That doesn't sound right. I hope FORCES is not a secret slave to the tobacco trade.

Page 5, finances - sorry I couldn't give Wanda a grant number! Somehow, I'm not a bit surprised that you fail to acknowledge that I've done this work on my own time, unfunded by external or internal sources, with no path to personal gain. I'm glad you were able to make some sort of connection, by I'm LOL again. This is really about letting people who use nicotine live longer and healthier lives. If you are paid to write articles like yours, then you've made more from my article than I have. To insinuate that I am profiting is incorrect, and way overboard on the conspiracy theory. Now you know, and you can decide what to do with the information.

I think the Nellie Nicotine charicature is overdone. The article is pretty explicit that youth don't make good decisions about addictive substances (in the sense that they eventually express disatisfaction with those choices), and that there is every reason to restrict advertising and sales of nicotine inhalers in the same ways that we restrict tobacco cigarettes. The warning labels should be different if the health risks are different. The nicotine warnings presumably should be fairly consistent across products. 

Let me refer you to two books that I read during a period of despair about smokers I knew who were, often to their own embarassment, destroying their lives for the weed. One is Ashes to Ashes. Early in the book, Kluger mentions that Christopher Columbus could not control his crew's tobaccco use. That's compelling. It has nothing to do with big pharma, obviously, but everything to do with whether people are going to use nicotine (or tobacco). The ensuing pages are similarly convincing, showing how tobacco use spread in the face of terrible personal health risks. So tobacco - or nicotine use - is inevitable, I think.

The second is Smokescreen. Hilt recounts at length the arguments of Addison Yeaman, a tobacco company lawyer anticipating the 1964 surgeon general's report. Yeaman thought the tobacco cos. should compete on safety and benefits of nicotine versus rauwolfia alkaloids (yikes), and just settle whatever lawsuits occured in the 60's. What a legacy he would have achieved! That path would have led to clean inhalers, my father would be alive, and I expect I would still be seeing a bunch of patients who are long departed. I think it is terribly unfortunate that the industry took the smokescreen path instead. 

I think a more balanced stance for your article to take would be to reject the "tobacco eradication" suggestions in my article (which, after all, had to appeal to the tobacco control audience rather than libertarians), while embracing the consumer choice and information suggestions. It seems to me that FORCES is so intent on whining about everything that it seldom makes constructive suggestions. Although you are appropriately suspicious of big pharma, surely it would be reasonable to let nicotine inhalers compete with cigarettes in the open market? That could be a banner headline on the FORCES site, with the subheading, "get regulations out of the way, give us choices." Or is it too painful to endorse even that much? I can see that it would be very painful if you were paid to promote tobacco. But FORCES is usually described as a smoker's rights group. Don't smokers have rights to choose between products?


--WS

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